No abstract

Pulmonary sequestration (PS) is a rare congenital malformation of the respiratory tract. Two main variants are described, the intralobar and the extralobar PS. Clinical manifestations vary from accidental findings to life threatening complications. Surgical resection is the definitive and indicated treatment of PS. The operation could be performed through an open thoracotomy or video-assisted thoracic surgery approach. We report the management of two patients with diagnosis of extralobar PS in the first case and intralobar PS in the second case. Both patients underwent uniportal video-assisted thoracic surgery resection of PS with success. In our experience, we confirm that uniportal video-assisted thoracic surgery is a safe and feasible approach for extralobar and intralobar PS. both reported cases MRI and angiography were not necessary because the angio-CT scan images were considered optimal for the identification of the aberrant vessels and surgical planning. Patient 1 (Figure 1)A 26-year-old female was admitted to our hospital because of left lower lobe pneumonia. At the clinical history the patient reports recurrent episodes of respiratory infection since childhood, much more frequent in the last 5 years. A computed tomography (CT) scan of the thorax was performed documenting the presence of a lesion in the basal segments of left lower lobe, with a diameter about 8.6 cm × 4.4 cm × 3.2 cm ( Figure 1A). The angio-CT-scan showed the presence of an aberrant arterial branch of the descending thoracic aorta measuring 9 mm in diameter connected to the lesion ( Figure 1B,C). Findings matched with intra-lobar sequestration. Further pre-operative investigations comprising bronchoscopy, pulmonary function test and echocardiography were strictly normal. Patient was recommended for surgery and she was referred to our department. Patient 2 (Figure 2)The patient was a 56-year-old woman with history recurrent respiratory infection and a recent endocarditis of the aortic valve with brain embolisms. After treatment of the endocarditis, the following cardiological, vascular and neurological evaluations were negative. Thus she underwent total body angio-CT-scan which showed an anomalous area of left lower lobe parenchyma separated with the normal one by an accessory fissure (Figure 2A,B) with two separate feeding arteries arising from the descending thoracic aorta suggestive for extralobar lung sequestration ( Figure 2C). Further, pre-operative investigations comprising bronchoscopy, pulmonary function test and echocardiography were strictly normal. The patient was recommended for surgery and she was referred to our department. Pre-operative preparationRoutine laboratory tests, chest X-ray, electrocardiography (EKG).Equipment preference card: all surgical instruments used were exactly the same for both patients. Patients positioningA double-lumen endotracheal tube is inserted, then, the patients are placed in a lateral decubitus on the table next to its anterior edge with the arm in the swimming position. The table ...

No abstract

No abstract

Primary spontaneous pneumothorax has been defined as the disease of the 'young and healthy'. There are multiple possible therapies and in recent years, surgery has evolved towards the use of the uniportal thoracoscopic approach. The objective of our study is to describe and present an innovative approach to access to the thoracic cavity in patients with spontaneous pneumothorax. The surgery was performed using a single access of 20 mm at the level of the 8th intercostal space. For the isolation and suspension of any dystrophic area, we use a 'loop' of non-absorbable braided suture inserted through the IV intercostal space and successive wedge resection using an endoscopic 10 mm mechanical stapler. Using this access, we were able to visualize and dissect the pulmonary ligament and perform complete pleural abrasion. We had no complications. The operative time was 60 min, the chest tube was removed the 2th postoperative day and the patient was discharged the day after. The operation we propose permits the reduction of the dimension of the access to the thoracic cavity. We were able to resect blebs without problems, the recovery was excellent and no complications related to the procedure were reported.

No abstract

Isolated unilateral pulmonary vein atresia (UPVA) is a rare congenital malformation and the management remains controversial. In adults, pneumonectomy is the treatment of choice when significant hemoptysis becomes life-threatening. We report a case of a 28-year-old male with isolated unilateral right atresia of the pulmonary vein who had life-threatening hemoptysis treated with bronchial arteries embolization followed by successful right pneumonectomy.

The self-expanding tract sealant device was created for the reduction of pneumothorax and chest tube placement rates after percutaneous lung biopsy. We used it for the first time for intraoperative localization of peripheral small solid nodules or ground-glass opacities with good results.